The Legacy of Trauma: Unhealed wounds

The Legacy of Trauma:  Unhealed Wounds
By Gary Reece, Ph.D.

We have witnessed another large scale traumatic event which in its concentric circles of victimization will traumatize not only individuals, but an entire community.  Aurora Colorado gets added to the list of unbelievably tragic events:  Columbine, Oklahoma City, Virginia Tech, 911, Tsunami, all are recognizable by just a word or letters.  What is not understood is that those who were the first responders also are impacted because they are “tough, highly trained professionals just doing their jobs.”  First responders after all of the events cited above have higher levels of addiction, depression, suicide, and failed marriages than ordinary citizens.  Why?  Because of the seldom recognized  and little known reason that they are terribly affected by what they do.

They are more vulnerable to trauma effects than the other victims because they are exposed to a high level of blood, horror, and devastating wounds they are expected to cope with.  We call them heroes, and they are, but that appellation does not immunized them from what they experience in the trauma scene.  They will be haunted by what they saw, smelled, touched, and waded through in their initial response.  They as well as all other victims are endanger of ending up with unhealed wounds.  The legacy of incomprehensible terrorizing, horrifying violent attacks against our humanity, communities and collective psyches is the very real danger of lasting and crippling wounds.  The first responders I have worked with are also in danger because of a culture of machismo which leads them to believe they should be “strong and invincible” unaffected by the events because to feel and be hurt by what they have participated in would leave them feeling like the rest of us: vulnerable and fragile, so they say they are “fine” and function right through the pain and horror.  It is only later that they are not fine.

The risk of these horrific, violent kinds of trauma, is that all affected become stuck, or frozen in time. An unhealed wound is by definition a failure or distortion of  the tasks of mourning and healing of psychic wounds due to trauma.  This failure to grieve a loss, this failed resolution can happen at any stage in the recovery process.  Another risk is secondary trauma, which can be attributed to insensitive media members violating the privacy of victims in their race to cover the event.

Recovery involves essentially 4 phases.  The first stage is Recognition.  The primary symptom of being stuck in this stage is either numbness or a total absence of feeling.  This is the residual of shock with feelings of unreality:  victims often remark that it felt “surreal, as if it wasn’t happening.” This is because the event is too overwhelming:  our psychological defenses cannot process that level of feelings all at once.Trauma by definition is an overwhelming experience that renders us shocked and helpless.

If healing is to take place it must be Recognized and the victim must find a way to work through denial and numbing.  This cannot be done all at once or merely a superficial, Yeah, it happened and I moved on.  This is still denial.  The worse the trauma the longer it will take to begin to feel and process what happened.  The risk at this stage is to our ability to feel anything, to  remain in a state of emotional deadness.  At one event I participated in, I did a critical incident debriefing  with a team of first responders to a plane crash at an airport.  One of the responders recounted that he couldn’t get the smell of the burned bodies off his skin and found himself taking a dozen showers.  Others reported similar experiences and found it helpful to talk about it together.

It should be stated that all of our reactions to unspeakably  high levels of violence are normal reactions  to abnormal situations.  This leads us to the second stage of mourning:  Recall, remembering.  This is when the very appropriate feelings of sadness, rage, emptiness, horror, confusion, regret, guilt, and failure begin to surface.  It is not uncommon for individuals to get stuck at this stage.  I have talked to individuals who walked around for years after the event stuck in rage.  They just can’t get past it.  Others become perpetually sad, their grief is worn like a second garment.  It becomes a part of their every waking moment.

Remembering and recall are critical to recovery because without them their can be no healing.  In order to heal we must be able to remember what happened, but not only remember but to recall and experience the feelings associated with the traumatic losses and residual effects.  This is what it means to grieve.  To permit ourselves to acknowledge the loss in its stark reality and work through all the difficult feelings.

This sets the stage for the next step.  Reconciliation.  What I mean by this is to actively work through the entire event and make sense of it by dealing with all the conflicting feelings and ways in which the event shatters our  beliefs and assumptions.  These events are horrific and shatter our view that life is orderly, just, safe, and meaningful.  When an insane person walks into a theater and begins shooting, this violates all of our assumptions about life and shakes our foundations.  We don’t feel safe, we fear for other acts of violence, we realize our vulnerability and go into a frenzy of trying to make ourselves and communities safe from random acts of violence and realize that we can’t because it keeps happening.

There is no timetable for mourning.  The myth that time heals all wounds is just that, a myth.  We all deal with loss in our own individual ways and each person experienced the event uniquely.  And because of this the task of rebuilding and reattaching is done at an individual’s own pace depending on how they were affected, what was lost, and their own resilience and community resources.  And it must be said that recovery depends in large part on the quality of the recovery environment.

In a community wide event, the entire community must come together and mourn collectively and be aware of the risks of mass tragedies.  Because we exist in community and our attachments to that community are what make us human it is critical that community leaders recognize the power of community in healing and that individuals not try to heal alone.  It is always inspiring to me to see the impromptu memorials which sprout up as if by magic at the site of the tragedy.  Rituals can be powerful ways to collectively mourn.

There are many signs of unhealed wounds.  Some things to watch out for are:

1)  A tendency to be hyper sensitive or to over react to anything having to do with the event.

2)  Restlessness or inability to relax and the need to be compulsively busy.

3)  Fear of recurrence and feelings of vulnerability.

4)  The tendency to over idealize the dead and enshrine them, remember they were human just lie us.

5)  Rigid, compulsive, ritualistic behavior that takes over your life.

6)  Persistent thoughts and preoccupation with elements of the loss.

7)  Blocked emotions,  Inability to feel or a constricted range of emotion.

8)  Inability to talk about anything related to the loss/avoidance.

9)  Relationships marked by fear of intimacy and fear of future disappointment.

10)  A pattern of self-destructive behavior or risk taking.

11)  Development of reliance on substances or abuse of medication.

12)  Chronic experience of numbness, alienation and isolation.

13)  Chronic anger, depression, irritability, intolerance.

14)  Total absence of mourning.  Acting as if nothing happened.

15)  There is a very long list of bodily symptoms:  insomnia, weight loss,
        anxiety,  and stress related illnesses.

The question I am most frequently asked is, “but why do we have to dwell on it?”   “Why don’t we just put it behind us and move on?”

Answer:  Avoidance leads to further complications and unhealed wounds.  Grieving is hard work, but necessary to restore our broken relationships, shattered communities, and wounded minds and souls.  We heal through the process of courageously facing, exploring, feeling, and talking with others.  We make sense of what has happened, face the insanity and meaninglessness of horrific violence and embrace our humanity.  In so doing we affirm the power of love and healing in our relationships with each other.